Members of Parliament have asked the company that runs the Sh53 billion insurance scheme for teachers to answer questions about cash charges for consultation fees for policyholders, delays in approvals and why the company's packages for other cadres of workers were different from those for tutors.
The National Assembly's Education Committee has asked Minet Insurance brokers, who provide the cover on behalf of the Teachers Service Commission (TSC), to provide full answers to at least four areas which it says are unclear and are causing untold hardship to teachers.
The MPs want the company to explain why teachers are forced to pay Sh500 as a consultation fee before accessing a specialist, even when their cover is up to date and against the fixed contract.
The committee is also seeking an explanation for the lengthy procedures that take up to four days to get approval from Bliss Hospitals, one of the insurer's accredited facilities, to refer a patient to another facility, even in emergencies.
The insurer, which also runs the MPs' medical scheme, will also be asked on Tuesday to explain how its packages, treatment and authorisations are different and more favourable to MPs than to teachers, who make up the bulk of the civil service.
The committee is also concerned that most of the new hospitals that Minet says have been included and can be used by teachers are not covered by any agreement with the Teachers Service Commission, raising the question of whether they exist only on paper and not on the ground.
On Tuesday, Minet management, led by managing director Sammy Muthui, failed to convince MPs of the scheme and was sent away to put its records in order and return on Tuesday next week.
"It is a constitutional obligation that you tell us the truth and we will put you on oath so that you can own up to the statements you make before the committee," Mr Melly said.
The MPs want Minet to account for Sh300 million it collected from teachers as co-payments in the last financial year.
Although Mr Muthui told the committee that the co-pay has been abolished since the beginning of this financial year, the lawmakers want a list of teachers who paid the Sh100, the exact amount collected and where the money is.
"We want you to provide this committee with the list of teachers who paid this Sh100 levy, how much was collected and where the money is," said Marakwet West MP Timothy Kipchumba.
"Most of these things you are telling us are good, but they only exist on paper. Teachers are not aware of them," said Mr Melly.
On Tuesday, the committee threatened to cancel the contract, saying it had received numerous complaints from teachers about poor service and that the multi-million-dollar medical scheme was not providing value for money.
The total amount of the contract, which is spread over three years, is Sh53, 580, 306, 270.
The amount in first year which runs from December 1, 2022 to November 30, 2023 is Sh 14, 890, 217, 547, in the second year which runs from December 1, 2023 to November 30, 2024, Minet will pocket Sh 17, 931, 261, 057 while in the third year which will commence in December 1, 2024 to November 30, 2025, the insurer will pocket Sh20, 668, 827, 666
Mr Muthui told MPs on Tuesday that TSC settled on a hybrid scheme in which inpatient, outpatient, dental, optical and maternity are capitated while funeral cover, overseas evacuation and excess of loss are insured. Due to its expertise on capitation, Bliss administers the capitated part of the benefits.
In the deal, teachers have access to 829 service providers across the 47 counties. These include 146 public hospitals, 133 mission hospitals, 63 anchor (Bliss) clinics and 487 private hospitals
As per the contract, Bliss is a capitation provider having its own network of 63 clinics across the country. These clinics are among the wider service provider panel currently consisting of other 771 primary service providers.
As a capitation provider, Bliss bears the associated risk of capitation and contracts and signs third party partnerships with service providers to provide access where there is no Bliss presence through an administrator, medical administrators Kenya Limited
The contract is renewed yearly subject to satisfactory performance of obligations by the consortium in the preceding year, a written confirmation of renewal by the commission based on satisfactory performance in the preceding year and availability of sufficient funding by the exchequer.
“The commission shall be at liberty to terminate this contract with no subsequent liability to the parties should the exchequer fail to fund or support the contract,” reads the contract.
